We heard an excellent talk about the "Hospital At Home" program from Kate Summers in March 2015. The intention had been for selected patients to be discharged directly from A&E to their home, or discharged early from their ward to home, with nursing care provided by visiting nurses at home. Despite all the preparation we understand that only one patient ever used the service as planned. The attached document from Fiona Slevin-Brown, head of strategy for the Berkshire West Federation of CCGs sets out how the program has been redirected and some lessons learned. Additional attachments describe how a related service has been operating in the state of Victoria, Australia. There is also a description of the Rapid Response and Treatment program (RRAT) which provides services for patients in care and nursing homes to enable them to have enhanced diagnosis and treatment without entering hospital.